56 HUMAN INTESTINAL PROTOZOA IN THE NEAR EAST 



Musgrave published an account of fifty such cases in the Philip- 

 pines. Others have had a similar experience elsewhere, and quite 

 recently the Thompsons (Journal of the Royal Army Medical 

 Corps, June, 1916) state that Bartlett had noted amoebic ulcera- 

 tion in the intestine of soldiers from Gallipoli who had died of 

 wounds or other cause when amoebic dysentery was not suspected. 



It is a remarkable fact that ulceration of the large intestine, some- 

 times quite extensive, can exist without giving rise to symptoms. 

 It is probable that in these cases where amoebic ulceration was 

 found after death, though quite unsuspected during life, an 

 examination of the stool would have revealed the condition of 

 the carrier case with cysts and free amoebae in the stool. 



In cases, such as those of Healy and Spiers mentioned above, 

 where there is a long history of repeated attacks of dysentery 

 extending over several years, and where during the intervals 

 between the attacks the stools are never normal, always being soft 

 and mixed with a certain amount of mucus, it is impossible to 

 doubt that there exists an extensive ulceration of the intestine. 

 In fact, thickening of the large intestine and painful areas can be 

 found on palpation. These cases during the interval between 

 attacks of dysentery show only cysts of E. histolytica and small 

 amoebae generally in very large numbers. In other cases between 

 the dysenteric attacks the stool may approach the normal and 

 mucus be not apparent, though the number of cysts and amoebae 

 passed may be very great. Furthermore, there are many carriers 

 who give a history of one attack of dysentery. In them there 

 must have been ulceration at this time, and it seems probable 

 that such ulceration must persist when acute symptoms are in 

 abeyance. Finally, there are the carriers who give no history 

 of dysentery whatever. In many of these a careful examination 

 of the stool will often reveal small flakes and streaks of mucus, 

 and though its presence is not necessarily an indication of acute 

 ulceration, it is proof that some abnormal condition of the intes- 

 tine exists, for it must be remembered that in the worst and most 

 persistent cases with undoubted ulceration present the condition 

 of the stool between the actual attacks of dysentery may only be 

 abnormal in that it is usually soft and unformed with a certain 

 amount of mucus present. In fact, the stool in these intervals 

 may be both macro- and microscopically exactly like the stool of 

 a carrier who gives no history of dysentery whatever. 



It is to be noted that a small percentage of these healthy carriers 

 complain of pain over the large intestine. 



